Category: Confidence

As I was driving to the Nashville airport after a successful week at HealthStream Summit I saw a traffic sign that read, “Stay in Your Lane.” It caused me to reflect on how often we inadvertently give messages to our best and brightest talent to keep their eyes focused on the road ahead and not to waver. Looking at my own career and experiences, the most memorable moments, achievements or sources of support came from those chances to go above and beyond or be on the receiving end of an individual willing to go the extra mile. Can we afford to stay in our lanes to achieve patient experience excellence?

The Patient Experience

When it comes to the patient experience, there is not a person in our care that wants us to deliver a checklist, only do our job. They want to know they are our biggest priority- they want to trust us that in their moment of need, we will not stay in our lanes- we will unapologetically go above and beyond for them. We will be brave to speak out in the event we see an error, pray with them when they are scared or losing hope, comfort their loved ones and sit at their bedside just a moment longer.

The realities we face in our day to day grind can sometimes cause us to lose perspective. My dear colleague Kathy Boswell, Director of Organizational Development at Brookwood Baptist Health, shared; as leaders if our employees do not see us at our best, how can we expect each patient to see us at our best. Kathy reminded me that we are always on stage.

I was asked to be the opening keynote at our Patient Experience Workshop (attended by a group of national leaders who are passionate about every patient receiving the best care possible) and decided to poll the standing room only crowd. I wanted to know what actions or behaviors made them feel most reassured when they were a patient. The results (below) were compelling… When we are a patient, we want confident employees, communication, and eye contact. None of these require a capital investment. We are all called to re-sensitize the powerful role we play each day as soon as we put on our badge. It’s time to take action! I challenge you to stand up and stand out among your colleagues. Lead by example and BE the difference in the lives of your patients.

Let us not get distracted by the grind, our glance time, our productivity and forget that every patient deserves our very best. We can’t have a different standard between what we would want for ourselves or our loved ones and what we want for our patients. Do you think we can afford to stay in our lanes to achieve patient experience excellence? Let me know your thoughts by leaving a comment.

2014 was one of the busiest years for infectious disease in the U.S. in more than a decade (Stobbe, 2014). Ebola dominated the news throughout the second half of the year, garnering more public attention than even the controversial mid-term congressional elections (Altman, 2014). Although Ebola received most of the attention, a number of other infectious diseases were in play, such as Enterovirus 68, the measles, whooping cough, and chikungunya. In fact, the number of threats from infectious diseases is so pronounced, one expert from the Johns Hopkins University School of Medicine contends, we are in the midst of an “epidemic of epidemics” (Bartlett, 2014).

As late as mid-2014, America was confident in its ability to handle such menacing infectious diseases as Ebola, with public officials touting our readiness on nightly news shows and the radio, but more recent experience has taught us a number of things:
• we are not impervious to outbreaks that occur halfway around the world,
• international travel severely compromises our ability to contain a large outbreak of an infectious disease, and
• we most definitely are NOT prepared for even one or two cases of something as serious as Ebola (Stobbe, 2014).

“Ebola has raised attention to serious gaps in our ability to manage disease outbreaks and contain their spread,” Jeffrey Levi, PhD, executive director of the Trust for America’s Health, reported to Medscape Medical News. “It was very disturbing that many of the most basic infectious disease controls failed when tested” (Lowes, 2014).

In response, hospitals throughout the U.S. are taking steps to improve preparedness. When the outbreak in West Africa first began, the message from the Centers for Disease Control (CDC) was that any hospital in the U.S. with private rooms should be equipped to care for Ebola patients (Healio, 2014). However, after the recent experiences in Dallas, the CDC has changed its position. Thirty-five hospitals throughout the country have now been designated
by health officials as Ebola treatment centers. The role of the local hospital is to identify a patient with Ebola and then send the patient to one of these 35 centers.

“All hospitals need to be prepared to identify and triage a potential patient with Ebola. Beyond that, it’s not realistic to think that all hospitals could deliver equally effective chronic care, nor it is practical to have all hospitals be prepared to do so,” says Keith S. Kaye, MD, MPH, professor of internal medicine and infectious diseases at Wayne State University School of Medicine, in Infectious Disease News in late 2014 (Healio, 2014).

Some experts worry that many hospitals have overreacted to the threat of Ebola and over-prepared for this one disease at the expense of other threats. According to several infectious disease experts at the University of California, “hundreds of hospitals have overspent, overconsumed, and overtrained for a rare disease that will most likely never pass through their doors” (Huffington Post, 2014). Rather, many infectious disease experts throughout the world
have voiced concern that we are not maintaining the ongoing vigilance and public health networks that are necessary to be safe from the broad set of threats we face. For example,
• each year, more than two million Americans get sick from antibiotic-resistant bacteria and more than 23,000 die from those infections;
• approximately one of every 25 people who are hospitalized contacts a healthcare-associated infection, resulting in roughly 100,000 deaths per year;
• more than 48 million Americans suffer from a food-borne illness every year; and
• an average of 62 million Americans—20 percent of the population—get the flu each year, causing between 3,000 and 49,000 deaths annually, depending on the strength of that year’s flu strain (Levy, 2014).

Last year, the CDC released its list of the top threats facing the U.S. They recognized several new and emerging infectious diseases, such as Ebola, but they also acknowledged long-standing threats from diseases like AIDS, polio, and the leading causes of death in America.

“When I was in medical school, the leading experts declared that infectious diseases had been conquered in the United States. It’s now clear how wrong they were.” – Dr. Eric Toner, senior associate at the University of Pittsburgh Medical Center’s Center for Health Security

Even though the U.S. faces numerous challenges from infectious diseases and the number of threats is on the rise, a recent report indicates that most states are not ready to respond. The Trust for America’s Health and The Robert Wood Johnson Foundation jointly released a study in 2014 that assessed all 50 states on their readiness to respond to infectious disease outbreaks. They monitored states on such metrics as funding of public health efforts, vaccination rates, infection control at medical centers, attempts to prepare for climate change, and surveillance efforts to track cases of HIV and E. coli. On a 10-point scale, no state received a grade higher than eight.

Half of the states received a score of five or lower. Only five states received a score of eight—Maryland, Massachusetts, Tennessee, Vermont, and Virginia. Arkansas received the lowest grade in the survey, with a score of only two.

The study’s authors refer to a U.S. trend to let its guard down when there is no imminent threat and then to find itself off-guard when threats like AIDS, SARS, or Ebola emerge. “When I was in medical school, the leading experts declared that infectious diseases had been conquered in the United States. It’s now clear how wrong they were,” Dr. Eric Toner, senior associate at the University of Pittsburgh Medical Center’s Center for Health Security, said of
the report (Levi et al, 2014).

The study recommended five steps the U.S. should take to better prepare itself for future threats from infectious disease. These include:
• ensuring that the U.S. has a strong public health system supported by strong laboratories;
• developing and implementing solid containment strategies, including vaccinations for contagious diseases and adequate treatment for chronic conditions;
• regularly training hospitals to be prepared for an epidemic that results in a flood of patients;
• improving communication with the public to keep them aware of threats from infectious diseases without causing panic; and
• increasing federal funding for vaccines, stronger antibiotics, and other treatments that can counter outbreaks (Levi et al, 2014).

In 2014, we came face-to-face with our nation’s lack of preparedness and the potential impact on the public’s safety. Hopefully, we will learn from our experience and work hard in 2015 to improve our readiness to respond to the infectious diseases that are a growing menace to our collective health and well-being.

How Deadly Is Ebola?

Ebola is one of the most deadly diseases known to man, with a fatality rate that is much higher than most other infectious diseases (50 to 90 percent). Since 2013, in the latest outbreak in West Africa, Ebola has infected 17,942 people and caused some 6,388 deaths.

If you want to achieve world-class levels of performance in the patient experience (or any other key performance measures) you must create a culture of accountability in leaders for achieving results and ultimately aligning the actions and behaviors of staff and physicians to help reach desired outcomes. HealthStream Engagement Institute has coached nearly 60,000 leaders, staff, and physicians over the last 12 months and, through that coaching, we have seen some interesting trends:

Yet, when we ask leaders if we could tell the difference between their high, solid, and under-achieving performers based on their annual evaluations, we overwhelmingly hear a common response: “No.” This problem is so pervasive that on our HEI patient-centered excellence survey of nearly 25,000 responses, the lowest scoring items include tolerance for poor performers and employee input leads to change. These gaps are magnified because organizations are allowing poor performers to continue undermining success. Meanwhile, leaders fail to engage and recognize their high performers. You can put any performance system in place. What is typically missing is how to establish the right accountability for outcomes. In our work with America’s hospitals and health systems, we find four crucial elements to understanding your strengths and gaps for creating a roadmap to sustainable accountability.

The following items are a limited portion of the evaluation process that HEI uses to determine the state of organizational accountability. Take a look and see how your organization scores.

CLIENT SPOTLIGHT

Phelps Memorial Hospital Center – Sleepy Hollow, NY

Phelps Memorial Hospital Center (PMHC) began a journey of transforming patient experience in February 2012, beginning with HEI’s Patient-Centered Excellence Assessment. That process provided them with a roadmap to improvement, part of which included enhancing their methods of leadership development and creating accountability for performance. Each level of leadership, from executives to frontline supervisors, has embraced their roles and responsibilities and committed to a long-term investment in their culture. As a result, PMHC has experienced drastically improved outcomes in employee engagement and the patient experience.

High-performing organizations create an environment of accountability where their top talent is aligned and engaged to produce the right results. This type of culture is pervasive throughout the continuum of employment, one which starts with the application and interview process and continues throughout the life cycle of an employee. An environment that is geared towards maximizing the potential of each member of its team and empowers them to improve things for themselves and those they serve will put your organization in the best position for success.

TODAY’S CHALLENGING HEALTHCARE ENVIRONMENT includes reconciling competing priorities and ensuring a culture of quality, safety, and continuous learning. Add the reams of data found in dashboards, Gantt charts, spreadsheets, and electronic reports for payroll, time off, compliance, and quality. It is easy to become distracted— especially with the realities of our economic climate and reform.

We believe that providing excellent patient experience is the foundation of competency in healthcare; yet, nationally only 70% of patients reported in 2013 that they received care at the “Best Possible Hospital” (HospitalCompare.gov, 2014). What can organizations do right now to support leaders, including frontline nurse managers, medical directors, and department directors, in their efforts to manage costs, direct resources, role model effective behaviors, and lead and inspire staff to provide the highest quality and cost-effective, patient-centered care?

It is imperative that organizations understand that embracing a culture of coaching is critical to ensuring patient-centered excellence. Coaching individuals on how to lead initiatives, deploy tactics, and give essential feedback to staff will help them be more successful sooner by creating a better path forward and avoiding common pitfalls to improving the patient experience. Whether your organization has a dedicated team for patient experience leadership or has a committed team of internal champions, this article is designed to support organization efforts to build the proficiency of coaching to overcome performance gaps and sustain progress.

WHAT GETS IN THE WAY OF SUCCESS?

The majority of the changes we see occurring in healthcare today are driven by a focus on a deficit or outcome that did not meet its target. It may sound contradictory, but with a sole focus on the “red” or “negative” performance, you miss the opportunity to develop, nurture, and invest in the bright spots, processes, or individuals who will ultimately achieve and replicate success for the organization. Without a culture of coaching, healthcare providers miss an approach that builds on strengths, promotes better outcomes, develops trust, and reinforces your most critical priority—the patient.

Many of the tools used to improve the patient experience are not new. Every leader and organization we encounter have already begun the journey to achieve patient-centered excellence. Many organizations have deployed proven techniques—hourly rounding, service recovery, communication models (such as HEI’s RELATE), and standards of performance. But if everyone is using them, why does achieving patient-centered excellence remain a challenge for so many?

Healthcare organizations expend significant effort with only limited success because they lack a culture of coaching. According to a 2014 BLG poll of nearly 200 leaders, only 12% of leaders reported use of transformation techniques to improve the patient experience are effective. These findings reveal that healthcare organizations have made significant efforts, but with limited success. Our data (Owens, 2011) shows that:

• Most organizations that embrace a new initiative, experience some improvement, but then regress back to their previous state.
• Managers in many healthcare facilities struggle with execution because they have too much on their plates for consistent focus.
• Underperforming leaders and staff don’t embrace change, naysay, and wait for initiatives to fail.
• Loss of discipline occurs because leaders are not equipped with new skills and accountability tools to sustain new behaviors and tactics.

In order for organizations to break through the challenges of the common scenario, coaching is critical to build on strengths, develop a plan to educate and reinforce patient-centered skills, and establish a platform for accountability. In our experience with assisting organizations through leadership development sessions, coaching roadmaps, and adoption of new or enhanced tactics and communication models, consistent feedback is that the most valued part of an engagement is one-to-one personal coaching.

For the leader and the department teams, obtaining validation that what he or she is doing in real time, the words and actions used, is a critical part of developing competencies and becoming expert in the realm of patient-centered excellence. A coach is in a unique position to observe, teach, mentor, give feedback, and in some cases, even to direct. A competent coach has the wider vision and is able to gain the trust and confidence of the leader, staff, or
physician who is coached; he or she is a great listener, an astute observer, and an effective communicator.

Use of PX Transformation Techniques

The Role of the Coach

Patient experience coaches and internal champions, when following a proven, executable blueprint, can accelerate an organization’s ability to achieve outcomes to support CAHPS, employee engagement, and physician loyalty successes. Coaching affords organizations the opportunity to hold up the mirror: they can praise what is working well and coach-up skills to take an individual or team to the next level. Coaching can create a platform to drive and support strategic initiatives to ensure a culture where every patient, every time has an excellent experience. We believe HealthStream Engagement Institute’s proven model that seeks to create alignment and develop internal coaches, leaders, staff, and physicians ensures development equates to successful execution and sustainability of gains achieved.

“I have spent many years of my career working towards a culture of ‘every patient, every interaction, every time’ and am passionate about improving the patient experience. But… it wasn’t until I had the opportunity to partner with HealthStream Engagement Institute and work directly with our coach that we realized a cultural transformation where we “always” place the patient first. Our patient experience scores continually improve and our patients keep coming back.” – Lynn Charbonneau, Director, Patient and Community Experience, Waterbury Hospital, Waterbury, Connecticut

HEALTHSTREAM ENGAGEMENT INSTITUTE’S PATIENT-CENTERED EXCELLENCE

Keeping the patient at the center of everything we do— every patient, every time. Assessing and developing the people who deliver care to understand and manage what the patient sees, feels, and experiences.

Alignment

In leading change, an organization, department, or service line must have a clear vision of where it is going; creating the message to communicate the “why” to staff and leaders alike is a critical element. Employees must grab onto the “why” before we can begin to teach them the “how and what” that ensures leaders are progressing. Coaches can identify strengths and gaps in current performance, as well as accountability and engagement for the organization’s journey. This alignment creates a unique coaching plan to assure the best means to develop and reinforce the desired change.

Development

You cannot expect leaders, staff, and physicians to automatically have proficiency in patient-centered skills and behaviors. It can, however, be developed.

Execution

Ensure that skills and proficiencies are executed well and consistently. Coaching plays a powerful role in validating that skills are transferred.

Sustainability

Constantly monitor outcomes and execution—this is key to maintaining focus. However, coaches must make certain to engage new leaders, staff, and physicians and ensure the onboarding process is aligned and that cultural expectations for the patient experience are maintained.

The Coaching Model in Action: Teaching Hourly Rounding

Alignment
• Build trust with the departments that need to adopt or improve hourly rounding.
• Discuss the benefits of hourly rounding and understand previous strengths or barriers to hourly rounding in the past.
• Agree to a policy and practice for executing hourly rounding and set non-negotiables (ex. No pass zones for call lights).
• Set time-bound goals for implementation and results monitoring.

Develop
• Work with department/division leadership to understand the skill of hourly rounding. Teach the leader how to validate hourly rounding through patient rounding, coach their staff on hourly rounding, and recognize great practice.
• Train the staff using evidence-based practice (HealthStream Engagement Institute recommends addressing 5 key patient needs: Pain, Positioning, Personal Needs, Potty/Bathroom, and Privacy) and use tools such as an hourly rounding log to visibly confirm hourly rounding with the patient.
• Work with the staff to develop Words That Work and the RELATE model for patient-centered communication to narrate their care and the hourly rounding process. Manage up the importance of hourly rounding to patients.

Execute
• As a coach, take the opportunity to let staff simulate hourly rounding.
• Use an hourly rounding competency tool to create development plans.
• Observe leaders validating hourly rounding and coaching their staff on hourly rounding.

Sustainability
• Use patient experience and quality outcomes as metrics of success.
• Leverage hourly rounding tools to ensure this evidence-based practice is occurring.
• Pair up high-achieving leaders and staff with team members who may be struggling.
• Celebrate, celebrate, celebrate successes.
• Integrate into new employee and leader orientation the skills necessary to adopt this practice.

The art of coaching can be applied to each and every technique you want to see adopted in your organization— and it produces results. Coaches trained in patient-centered excellence are in a unique position to see, assess, design, and tailor coaching to address an organizations’ challenges in providing not only clinical excellence but service excellence. Coaching supports developing your workforce and building your most critical assets—your people.

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Thinking of all the strong, powerful women on the CPQCC staff and at our member hospitals who work tirelessly to ensure that every pregnant woman and infant in California is given an equal chance to thrive. Today and every day we #Pressforprogress #IWD2018